“Why should I take a cholesterol medication if my cholesterol isn’t high?”
This is a question I heard recently from a new patient, Greg (not his real name, of course). Greg’s seeing me because he had a heart attack a year ago, and he wants to make sure he’s doing everything he can to prevent another one.
Overall, Greg’s doing quite well. He’s active, he quit smoking. and he’s taking his blood pressure medications as directed. However, he stopped the cholesterol medication because he didn’t think he needed it. As far back as he can remember, his doctors have told him his cholesterol numbers are good. Why would he need a cholesterol med if his cholesterol was OK?
He was surprised when I recommended that he start taking his cholesterol medication again.
What are Statins?
The medication that Greg had stopped was a statin. Statins are commonly referred to as “cholesterol medications” and are one of the most prescribed medications in the world. They are also one of the most controversial. There is a lot of debate about who should be taking a statin medication. While there are passionate people on both sides, often the “right” answer is mostly dependent on the goals of the patient. It’s my role to explain the risks and benefits of taking a statin. And, while I don’t tell the patient what to do, I do emphasize that countless studies have proven that statins do decrease the risk of heart attack, stroke, and death in those who are at high risk for heart disease.
They’re Not Just for Cholesterol
Why did I recommend that Greg restart his cholesterol med if his numbers were good?
There are 3 reasons:
1) What is defined as “good” cholesterol numbers depend on the patient’s risk. Cholesterol numbers that are perfectly acceptable in a young person with no risk factors, might not be acceptable in someone with a high risk of heart disease. Greg had a heart attack in the past, which puts him in a high-risk group.
2) It’s not just about lowering cholesterol numbers, but HOW the cholesterol is lowered. Although we call statins “cholesterol meds”, what we primarily use them for is to lower the risk for future heart attack and stroke. This is an important point because not all cholesterol medications are the same. Some (such as some niacin-based medications), make cholesterol numbers look better, but don’t change risk and are rarely used.
3) Statins have been shown to lower risk even in those with normal or low cholesterol numbers. Rather than “cholesterol meds”, statins would be more appropriately called “risk meds”.
Once Greg understood why he was prescribed a statin (not just to lower his cholesterol, but more to lower his risk for future heart attack and stroke), he was glad to start taking it again.